Published on 4 May 2023

Latest NICE guidelines recommend finerenone for treatment of chronic kidney disease.

A new treatment is now available for patients with chronic kidney disease through NHS

England following the publication of new recommendations by the National Institute for Health and Care Excellence (NICE).

Chronic kidney disease is a complication often associated with type 2 diabetes – it is estimated up to a third of people living with type 2 diabetes have kidney disease.

The condition develops over many years and can affect anyone with type 2 diabetes, caused by damage to the small blood vessels in the kidneys.

Finerenone is recommended as an add-on to optimised standard care, which should include, unless they are unsuitable, the highest tolerated licensed doses of angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers (ARBs), and sodium–glucose cotransporter-2 (SGLT2) inhibitors.

Publication of the NICE guidance on finerenone is based on the results of studies investigating the safety of finerenone on kidney and cardiovascular tests in 5,734 adult patients with chronic kidney disease associated with type 2 diabetes.

The study showed that finerenone significantly reduced the risk of kidney failure.

Dr Kieran McCafferty, Consultant Nephrologist at Barts Health NHS Trust, said: “People with chronic kidney disease associated with type 2 diabetes have significant risk of progression to kidney failure or premature death, particularly due to increased risk of cardiovascular disease compared with people with chronic kidney disease alone. There has long been an unmet need for additional treatment options for people with chronic kidney disease associated with type 2 diabetes, especially as the residual risk of kidney disease progression and cardiovascular events remains high despite current therapies.

“The NICE recommendation of finerenone is therefore very welcome news and provides physicians with an important add-on option for protecting our patients by delaying kidney disease progression.”  

A man holding his back.

Dr Raj Thakkar, GP, Present Elect and chronic kidney disease lead, Primary Care Cardiovascular Society (PCCS), said: “Chronic kidney disease is one of the most common and burdensome complications of high-risk conditions including diabetes and hypertension. Without early identification and optimisation of treatment, chronic kidney disease progresses over time leading to accelerated adverse renal and cardiovascular outcomes including end-stage kidney disease and coronary disease, heart failure, valve disease, stroke, and peripheral vascular disease. Building on the NICE guidance, the PCCS is developing a quality improvement programme to support colleagues to systematically and proactively identify and manage chronic kidney disease in the primary care setting.” 

Alison Railton, head of policy and external affairs, Kidney Research UK, said: “Chronic kidney disease associated with type 2 diabetes is now the leading cause of kidney failure in the UK. It has a debilitating impact on patients’ lives yet is still not recognised as a major health condition. This recommendation from NICE provides an additional treatment option and is good news for thousands of patients living with this long-term condition across the nation.”

In the UK, it is estimated that over 4.4 million people are living with type 2 diabetes, including almost one million undiagnosed, and as many as 40% of people with type 2 diabetes – approximately 1.76 million people, could eventually develop chronic kidney disease in type 2 diabetes.

A recent survey of patients with chronic kidney disease associated with type 21 diabetes (in the UK, France, Italy, Germany, and Spain), developed by the European Kidney Patients Federation in collaboration with Bayer AG, which included 100 UK patients, highlights that a chronic kidney disease diagnosis not only has a profound physical impact on patients, but can also affect all aspects of a patient’s life including career, finances, and mental health.

Results found that respondents in the UK were the most likely to have experienced depression (67% vs. 57% overall) with chronic kidney disease in type 2 diabetes.

Findings of the survey, published on this year’s ahead of World Kidney Day 8th March, also revealed that delays in chronic kidney disease diagnosis are common across countries and there is a lack of awareness of chronic kidney disease and its symptoms among type 2 diabetes patients – in the UK.

Half of the respondents knew nothing about chronic kidney disease prior to their diagnosis, despite the known link between type 2 diabetes and chronic kidney disease.

Dr Antonio Payano, Senior Bayer Representative, Head of Pharmaceuticals at Bayer UK and Ireland, said: “We are thrilled that finerenone is now made available to eligible adults in England who live with chronic kidney disease associated with type 2 diabetes, a condition that is associated with poor health outcomes for patients and high expenditure to the NHS services when managing the end-stage complications of chronic kidney disease. We will continue to support the NHS and healthcare professionals to bring this treatment option to benefit more patients.

“Given the rising prevalence of type 2 diabetes, we are fully committed to raising awareness of chronic kidney disease among type 2 diabetes patients and working with physicians on chronic kidney disease knowledge sharing to help improve diagnosis and empower patients for better outcomes.”

Read the NICE guidance here

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